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成人呼吸窘迫综合征(ARDS)发病急骤,病死率高。文献报告平均死亡率达60％。我科曾抢救成功1例重度阿米(口替)林(Amitriptyline)中毒并发ARDS,报告如下。患者女,21岁。既往健康。次日早上被发现昏迷于床上,在住房发现阿米(口替)林空药瓶1个,即送急诊。体检:中度昏迷,P100/分,R20/分,BP14/8kPa,双肺未闻啰音,心律整。即予病人洗胃,补液,利尿和对症处理,入ICU监护。经治疗,病人神态一度清醒。追问其病史,自诉入院前10小时自服阿米(口替)林100片(总量2.5g)。入院后24小时,病人出现呼吸困难,烦躁,唇与指甲出现发绀。再度转为浅昏迷,HR120/分,R40/分,全肺可闻湿日罗音。考虑病人有ARDS可能,做血气分析,胸片检查,并即行气管插管,接呼吸机,以呼气末正压(PEEP)方式行通气。胸片显示右上肺及下肺斑片状阴影。临床征象
Adult respiratory distress syndrome (ARDS) the incidence of sudden, high mortality. The average reported death rate of 60%. Our department has successfully salvaged 1 case of severe Amitriptyline (Amitriptyline) poisoning complicated by ARDS, the report is as follows. Female patient, 21 years old. Past health. The next morning was found unconscious in bed, found in the housing Ami (oral) Lin empty bottle 1, that is, emergency room. Physical examination: moderate coma, P100 / min, R20 / min, BP14 / 8kPa, lungs unheard rales, rhythm whole. Namely to the patient lavage, rehydration, diuretic and symptomatic treatment, into the ICU custody. After treatment, the patient was once awake. Asked about their medical history, self-suing 10 m before admission to self-service Amie (mouth for) Lin 100 (total 2.5g). 24 hours after admission, the patient developed dyspnea, irritability, cyanosis of lips and nails. Once again turned into a shallow coma, HR120 / min, R40 / min, the whole lung can be heard wet rales. Consider the patient may have ARDS, blood gas analysis, chest X-ray examination, and the line endotracheal intubation, ventilator, positive end expiratory pressure (PEEP) way ventilation. Chest radiograph shows the right upper lung and lower lung patchy shadows. Clinical signs